TOP 10 EXERCISES TO STRENGTHEN VMO (Vastus Medialis Obliquus)

| September 13, 2011

Eliminating Anterior Knee Pain through Exercise (At home)

 

There are millions of people who suffer from anterior knee pain, or as it is sometimes called Patellofemoral Syndrome (PFS).

Sufferers usually struggle with movements such as squatting down, or climbing stairs.  Quite often, this pain is often made worse when going down.

For many people, these movements are part of their daily routine and the pain that is experienced places a large strain on their quality of life.

Often, this pain is completely unnecessary and can be eliminated if the right diagnosis is made and the right treatment strategy is put into motion.

Listed below are 10 great exercises that will help PFS sufferers by strengthening the vastus medialis obliquus (VMO); the muscle which helps controls the way the knee cap moves when we bend and straighten our knees.

VMO – incredibly important for patellar control during knee flexion and extension

This muscle is incredibly important, therefore maintaining the optimal recruitment levels are essential to keeping our knees happy.

If you are a PFS sufferer, and have been given a rehab programme, there is no reason why you can’t say bye to your knee pain very quickly; especially if the programme is performed consistently and with good technique.

From experience, I wouldn’t bet against you noticing a massive decrease in your pain levels within the first week.  Little decreases in the pain your feel when you’re walking downstairs make a huge increase in your quality of life.

Pain is a hardship.  It bogs you down, prevents you doing what you would normally do.  It has not only physical implications, but psychological ones too.

It tells our brains that we can’t do that particular movement or we’ll feel pain.  So we adapt to do the movements differently and cause further compensations which leads to other problems and pain.

However, if you use the combination of foam rolling (SMR), Static Stretching, and rehabilitative exercise, I can guarantee that you will reduce or fix your PFS pain.

 

EXERCISE GUIDELINES

  • make sure that an appropriate physical specialist such as a physio, osteo or sports rehab therapist has diagnosed, and advised you to begin treatment for PFS
  • always perform each exercise with perfect technique
  • Perform the exercises in the order they are presented.  Once the exercise has become too easy, slightly increase the repetitions or the time held for the contraction before moving on to the next exercise.
  • Stop if your knee starts to feel worse and contact your physio, osteo or sports rehab therapist for advice and to discuss future treatment

 

We’re hoping to have a library full of pictures to help you through these exercise descriptions very soon! Watch this space.

 

1. SITTING ISOMETRIC CONTRACTIONS (Toes facing slightly out)

  • Sit on the ground with your legs out in front of you.
  • Place your first 2 fingers on your VMO. ( Refer to the image above if you don’t know where that is)
  • Tighten your quad muscles and imagine pulling your knee cap upward towards your hip
  • Hold the contraction for up to 10 seconds and make sure you feel VMO working (aim to contract that muscle first)

Note: For those doing this exercise for the first time, try to perform 10 repetitions for 5 second holds.  Once this becomes easy, increase the length of the hold to 10 seconds and decrease the reps by 5.  Once that becomes easy, start to increase the reps until you’re up to performing 10 repetitions for 10 seconds holds.

2. SEATED ISOMETRIC VMO AND ADDUCTION CONTRACTIONS

  • Sit on the ground with your legs out in front of you.
  • Place a pillow, cushion, or a foam roller between your thighs
  • Place your first 2 fingers on your VMO.  (Refer to the image above if you don’t know where that is)
  • Tighten your quad muscles and imagine pulling your knee cap upward towards your hip
  • At the same time, squeeze the pillow, cushion or foam roller between your thighs
  • Hold the contraction for up to 10 seconds and make sure you feel VMO working (aim to contract that muscle first)
Note: For those doing this exercise for the first time, try to perform 10 repetitions for 5 second holds.  Once this becomes easy, increase the length of the hold to 10 seconds and decrease the reps by 5.  Once that becomes easy, start to increase the reps until you’re up to performing 10 repetitions for 10 seconds holds.

 

3. FOAM ROLLER LEG EXTENSIONS
This one is very handy, especially if were smart enough to get a foam roller to release the tension in the outside structures of the thigh.  Foam Rollers have many purposes!

  • Sit on the ground with your legs out in front of you
  • Place the foam roller under your knee
  • Place your first 2 fingers into VMO and tighten your quad muscles, lifting your foot off the ground and contracting your thigh
  • Hold the contraction for up to 10 seconds and make sure you feel VMO working (keep trying to feel it if you can’t at the start!!)

 

4. PLIE KNEE BENDS
For those who don’t know what a ‘Plie’ is, it is similar to a ballet move where you do a 1/4 squat  with your knees going out slightly to the sides.

  • Stand with your knees hip width apart and your toes pointing slightly out.  Imagine them at 12 o’clock at the start and pull them to roughly 2 o’clock.
  • Squat down slightly and let your knees follow your toes
  • Concentrate on VMO and ‘pull’ your legs back up mostly using VMO
  • Gradually build the amount of reps up to 15, making sure that they are all done with perfect technique

 

5. BALL SQUATS
This is one of the first exercises I would do with a client if they had difficulty performing a bodyweight squat.  Once you build up the strength in your legs, remove the ball and concentrate on using only your bodyweight.

  • Place a Swiss Ball against a wall and lean into it with your lower back supported
  • Gradually lower yourself into a seated position, pushing your hips backward (as if you were trying to touch your bum against the wall, but be conscious to push your knees forward at the same time)
  • Lower yourself until your thighs are roughly parallel with the floor
  • Push through the heels and squeeze your thighs until you are standing vertical again

 

6.  SPLIT SQUATS (STATIONARY LUNGE)
This is an exercise I refer to as a stationary lunge that is performed at the mid-way point

  • Start with your feet hip width apart and take a slightly longer than normal step out with one leg
  • Keep most of your body-weight through the front leg, but particularly through the heel of the front leg
  • Slowly start to lower your self down, pushing back through the hips and maintaining a fairly upright position
  • Make sure that your knee is also being pushed forwards, but the heel remains in contact with the floor
  • Once you are in the bottom position, push through the heel of the front foot to return to the starting position
  • Concentrate on VMO through both the raising and the lowering of the movement
  • Start off with lower reps such as 6-8 and build them up until you reach 12-15
  • Hold onto a railing, wall, or broom handle for support if balance is an issue
  • Gradually add more weight through the use of dumbbells, a barbell or even a knapsack on your back

 

7. SINGLE 1/4 LEG SQUATS
This can be a difficult exercise for some people.  Make sure you are well balanced and use a railing, wall or broom handle for support if needed

  • Stand with your feet hip width apart
  • Slowly raise one of your legs off the ground (bring your heel towards your bum)
  • Slightly point your toes out to the side (5-10 degrees)
  • Slowly push the knee out over the toes, concentrating on holding VMO
  • When you reach the bottom of the movement, pull the leg back up using VMO
  • Maintain good hip alignment throughout and use a railing, wall or broom handle for support if balance is an issue
  • Start off with lower reps (6-8) making sure that you can feel VMO, and gradually increase the reps up to 12-15 as your strength improves

 

8. STEP-UPS

  • Stand in front of a step, or a stair
  • Step up onto the step, ensuring that your knee is in line with your toes and hip
  • Pull through the heel and contract VMO to pull yourself upward into a straightened position
  • Maintain the contraction in VMO, keep your heel on the step and knee over the toes on the lowering phase
  • Start off with lower reps (6-8) making sure that your balance is good and you are using VMO
  • Increase the height of the step as you improve and up the reps to 12-15

 

9. STEP-DOWNS

  • Stand on top of a step or chair
  • Make sure your weight is through your heels and slowly lower yourself down to the floor
  • Concentrate on maintaining a contraction into VMO and keep an upright posture
  • Keep your hips level
  • Start off with lower reps (6-8) making sure your balance is good and you are using VMO
  • Increase the height of the step as you improve and up the reps to 12-15

 

10. RUNNING AND SPORT SPECIFIC ACTIVITIES

  • begin by performing straight runs on a flat surface
  • increase the challenge by incorporating sport specific motions.  For example, side to side movements, hops, twists and jumps are all movements that are specific to many different sports.

Tags:

Category: Knee Injury Prevention

Comments (25)

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  1. Cath says:

    Such great exercises! Thanks.
    Any chance of getting a few pictures for Ex 4, 6 and 7?

    • Craig says:

      Hi Cath,

      we’re hoping to get some pictures done ASAP. I’m sorry it’s taken so long to get it done. We hope to have it completed by the end of the month.

      Cheers

      Craig

  2. mei says:

    Regarding the Step Ups and Step Down – how would one be able to do that when stepping up causes pain?

    • Craig says:

      Hi,

      Thanks for the email.

      If you are experiencing trouble stepping up, I would advice regressing back through the exercises to the more easier ones; master those, and then progress back until stepping up causes no further problems.

      I hope that this helps

      Please let m know if you experience any further trouble

      Craig

      • Cecilia says:

        Thanks for the article, that is a great set of excersices. I would like to see some pics or videos.

        I am an endurance cyclist, and this summer I have been having pain on my knees due to a patello femoral problem also my kneecaps are displaced to the outter side.
        The foam roller have been of a great help to massage and loose my muscles.

        My target now is to get the VMO muscles because they are very little.. :( any special advice?

        thanks lot!

        HG

  3. michael says:

    Hi Craig,
    Genetically, I have underdeveloped teardrop muscles… That and ankle injuries have led to patella drift, and knee pain. For years this affected me until I took up routine goalkicking practice in rugby. My knee is perfect now. I am 38.. although all the practice led to an anguinal hernia (a small price to pay I think, but demonstrates how intensely I was practicing, and how effective this movement is to arresting a weak VMO).
    On this subject, I would love you to reveal your number 1 gym (or other) exercise that I can use to push and really develop my VMOs more than ever before?
    Thanks
    Mike

  4. Dawn says:

    My daughter is 6 months post op (microfracture surgery), she is gradually building up her quads but her vmo is not building up at all. We know squats are probably the best for this but she still has pain where the weight bearing articular cartilage is damaged. Have you any suggestions for a variation of squats where she won’t be putting too much pressure on her knee? We have been told she has weak vmo anyway,it’s like the quads are firing ok now but the vmo is asleep?

    Dawn

  5. Jules says:

    Help! I’m in escrow, recently got diagnosed with PFS, I am 45 and in good shape. The problem is, we are moving into a 2 story home. The stairs aren’t too hideous, about 6 steps up. I am wondering if I’m making a mistake moving into a 2 story home. Any suggestions? And please pictures with the exercises would be so helpful.
    Thank you!
    Jules

  6. Suyash Bhandari says:

    Great Exercises!!!! particularly, for anyone whose struglling from Patellofemoral pain….
    Thank You.

  7. Glenna Lynch says:

    It’s spelled Plie. As a ballet dancer turned PT, I couldn’t leave it without comment.

  8. abhinav says:

    i had acl surgery 2 yrs back with bptp graft using bio-degradable screws.but even after such a long time i am unable to run.my VMO is almost unnoticable.i some tine feel pain while walking..it seems like knee would bend inward.how much time does it take to get normal.if i do these exercises..

  9. daniel says:

    Awesome post! Would be even better with pix since a picture is.worth a thousand words!

  10. Resa says:

    Hi! I just came across this site and it’s very helpful. I was wondering if you may have some general advice for me. I have horrible knee pain, but I’m very athletic. I cycle, I run, and I lift. I have awesome genetics because my dad has natural muscles but my mom also gave me her genetic weak knees. So my question is. Am I at the pinnacle of how strong I can get my knees? I do weighted squats, jump lunges and the cycling really helps, my muscles are fine but sometimes I have to stop so my knees can relax a bit. I have been reluctant to do solely VMO exercises because I think I already work out enough with my other exercises and that they should be strong enough. Am I wrong? My knee pain sucks hah…Any advice would be great! Thx :)

  11. Joe says:

    Hi Craig, Like the article! I had been doing straight leg lifts with a 10 pound ankle weight and my toe pointed slightly outwards. 100 reps

    After more than 8 weeks of that I still didn’t really see much improvement in the VMO as compared to the uninjured leg.

    So now I’m trying the foam roller leg extension with 10 pound ankle weight. And I can feel a nice strong isolated VMO contraction.

    I’m hoping that this will work better!!

  12. Barbara says:

    I’ve had 2 knee ops & still in pain. My VMO has shrunk & is very weak. Do I just start with exercise #1 until it seems easy then #2 etc or should I do say the first 3 & then move on when mastered without pain. Really want to get back to running. Had almost given up until I read your article as each time I try & strengthen muscles knee hurts so I give up.
    Thanks

  13. sushil vijay says:

    Dear sir, its so gud to learn these exercises. Can U suggest me sum book on individual muscle strengthening exercises . Kindly reply on my mail.
    regards
    sushil Vijay

  14. Akiko says:

    Aww, finally some great exercises to work on strengthening my VMO, thanks!

  15. shilpa mahey says:

    Hi,Craig
    This is Shilpa mahey .from India .i would like to thank u for dis wndrful knwledge …I want to knw the
    Degree of squat in plie knee bending….

    Thanks n regards

  16. shahab says:

    thanks for these exercise

  17. Sakya says:

    Thank you for this. I’ve had problems with dislocating patellas since early teenagehood so am quite familiar with what is required for rehab. Got a bit less frequent in my 20s and now it’s just happened again after being stable for about 3 years. Just needed a reminder of what exercises to do, knew exactly what to search for & was happy to find your website. The exercises are very well described.

  18. girish says:

    Have been following few of these workouts for a fortnight now. Great difference, I can feel it diminishing every passing day. Hope to post another reply once its gone.
    Thanks a ton Craig.

  19. Saleh says:

    There is a nice way to find out if you have the so called PFS. Close your knee and press your fingers on the sides of the knee. if you feel the pain then you must perform the above required training.

  20. Herman says:

    I like your statement “any pain can be improved upon if not completely eliminated.” My knee pain disappeared after buying a new pair of running shoes and stretching before exercising. Will incorporate some of these exercises.

  21. Fede says:

    All this exercises are great but I would add what I think is the best exercise and the one that absolutely everybody can do. For years I suffered from knee pain inmy patella playin basketball. With just 2 sets of this exercise prior my playing i was able to play pain free. I saw it in the NBA website its the number one knee rehab exercise,safe and soooo efective
    EXERCISE
    Lay down with your legs extended infront of you at shoulder with apart.Now sit yourself and rest your body on your elbows while looking at your feet.confortable.Now bend the unaffected leg to 90º placing your heel on the floor,your injuered leg is still extended.Still confortable.
    Now just lift you injured leg KEEPIN IT STRAIGHT,raise it slowly until the quad meets with you bent leg quad. Hold up there for a few seconds and lay your leg down slowly.the timing should be 3sec raising,3 seconds upthere,and 3 seconds down,or 3-5-3. You can add ankle weights but I dont advice it.It better increase the time at the top instead of weight.
    Its quite simple I just explained it in deatil so every body got the picture.Do this morning and night.sets of 10 reps. The more the better. Also dont be shy to lay down before your game/rase and do this.It will activate your VMO prior practice and warmup your knee for pain free exercise.
    Then you can go to the rest of exercise written ehre that are faboulous too.Specially the 1 leg step ups and down.But people,this exercise is a must an a heaven sent for me

  22. Fede says:

    I may also add that the cho pat or mueller patella straps are great and alow you to keep playing.they press the patella alittle bit so it doesnt rub witht he kneecap and no inflamation occuurs.Needless to say,ice after every work out..but yeah all that just fights symptoms,the best thing that worked for me was VMO strenghning and this exercise in particular.You strengh your knee without range of motion or pain and without cuasing more inflamation.peace